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What effects can stress, smoking, diabetes, cancer and HIV have on our teeth?

To get that beautiful smile, dental hygiene is absolutely essential. But this isn’t always enough. There are other factors that encourage oral and periodontal diseases which you have less control over. Smoking but also diseases like diabetes, infections, cancer and stress are factors which have known risks for your oral health. Dr. Frédéric Duffau, dental and periodontal surgeon in Paris, gives us an overview of what can affect your teeth.

What destroys your teeth?
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Doctissimo: Aside from dental hygiene, what are the main factors which cause dental and periodontal disease?

Dr Frédéric Duffau: The risk factors most studied are connected to genetics and the environment. They include smoking more than 10 cigarettes a day, stress (bereavement, depression, harassment at work etc) and diabetes that is not controlled (type 1 or 2). In the most recent studies, obesity and smoking cannabis (more than 40 joints a year) are also risk factors. Stress is an aggravating factor, especially in cases of depression or anxiety.

In the past year and in my private consultations, patients presenting periodontitis (inflammation caused by an infection which makes the teeth loosen) are mostly smokers. 23% have smoked in the past and 3% are diabetics undergoing treatment. Almost half have experienced extreme stress in the past year and half of patients have a hereditary disposition.  

Doctissimo: What effect does smoking have on your gums, teeth and their roots?

Dr Frédéric Duffau: Smoking encourages the appearance and development of periodontitis through increasing the levels of bacteria which could lead to disease. On top of this, smoking also limits the ability of the body to repair or regenerate the gums during treatment.

According to research studies, smokers have between twice and eight times as much chance of developing periodontitis than a non-smoker. The more you smoke, the more the risk of periodontitis increases. Smoking reduces blood flow chronically and increases vasoconstriction in the gums, producing a harmful effect on the cytokines (molecules which cause the signs of inflammation), reducing the body’s natural defences against bacteria and plaque, and acting on growth factors (involved in regenerating gum tissue). Finally, smoking inhibits the growth of fibroblasts and the production of collagen. Note that a smoker is six times more at risk of developing oral cancer than a non-smoker.

Doctissimo: So smoking is directly responsible for the development of certain types of dental disease?

Dr Frédéric Duffau: It is not possible to single out any one particular factor. Periodontitis remains a disease which is caused by many different factors. It can be caused by the systematic presence of bacteria in high quantities on the one hand, but also by the presence of at least one environmental or genetic risk factor. It is important to note that smoking is, after oral hygiene, the main factor which can be changed. Dental professionals should help the patient stop smoking by giving them information on the part smoking plays in the development of periodontitis. This helps 1 in 55 patients quit smoking.

Doctissimo: Should someone who is diabetic be observed more carefully?

Dr Frédéric Duffau: According to important epidemiological studies, the risk of developing periodontitis is 3 to 11 times higher for a diabetic patient whose diabetes is not managed, than for someone who is not diabetic. When diabetes is managed properly, this risk is the same as for non-diabetic patients.

Chronic hyperglycaemia in connection with diabetes can lead to slower healing of tissue and a greater susceptibility to infection, like periodontitis. In other words, a  diabetic patient whose condition is not controlled, should be given special attention when it comes to their teeth. If the patient’s condition is not under control, he or she should be given regular check-ups to ensure that the patient has good dental hygiene. These individuals should also have regular scale downs to ensure the surface of the teeth is clean. On the other hand, a patient with properly managed diabetes will be considered the same as any other patient.

Doctissimo: What kind of effects do diseases related to the immune system (HIV, cancer) have on the teeth?

Dr Frédéric Duffau: Chemotherapy leads to numerous oral and dental anomalies; infections, pain, bleeding and problems with taste buds. The side-effects of this kind of treatment lead to a risk of infection in general, dehydration and malnutrition, as well as in cases of depression because of the incapacity to communicate. Radiotherapy can also affect the mucus (these effects are reversible), salivary glands (leading to trouble with pronouncing words, nutrition and the immune system) and blood circulation (increasing the risk of osteonecrosis where the bone dies after dental surgery, which can itself lead to infections that are difficult to cure).  

Patients with HIV are exposed to an increased risk of candidiasis (yeast infections, which affect 60% of HIV patients), in comparison to diabetic patients and those who are undergoing chemotherapy treatment for cancer. The risk of ulcero-necrotic gingivitis and ulcero-necrotic periodontitis is also increased. These conditions cause extreme inflammation of the gums, accompanied by pain on contact, gum redness and spontaneous bleeding. This type of infection can also be experienced by patients who smoke a lot, and those who have been having periods of severe stress (more than 5% of patients with HIV).


Sources :
- Interview with Dr Frédéric Duffau, dental and periodontal surgeon in Paris, May 2012.
- ParoSphere Organisation
- Paradontol 2000. 2007;43:267-77. Literary Review.
- Dental and oral diseases, on the French Ministry for Health’s website.
- *Epidemiology of periodontal status in dentate adults in France, 2002-2003, J Periodont Res 2007; 42: 219-227 (find it online here).

Posted 06.07.2012

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